Knowledge, Attitude and Practice Towards Patient Safety Among Nurses Working at Selected Hospitals in Mogadishu-Somalia

Knowledge, attitude and practice towards patient safety among nurses
working at selected Hospitals in Mogadishu-Somalia.
CHAPTER ONE
INTRODUCTION
1.0 Introduction
This chapter of the research discusses the background on the study, statement of the research
problem, purpose of the study, objectives and research questions. It continued to discuss on the
significance of the study and finally operational definition of terms.
1.1 Background of the study
Patient safety is defined as the prevention of health-care-related errors and adverse outcomes
(Asem et al., 2019).
World Health Organization has also defined patient safety is defined by as the absence of
preventable injury to patients and the prevention of unnecessary harm by healthcare providers (Lu
et al., 2021).
The evidence shows in Ethiopia approximately 98,000 persons die per year because of the medical
errors that happen in hospitals. This is more than the death from motor vehicle accidents,
workplace injuries, and breast cancer. Moreover, the financial burden of human tragedy and
medical error easily increases to the peak ranks of urgent and widespread community issues (Kohn
et al., 1999).
The provision of care in clinical settings is linked to a number of issues, including therapeutic side
effects, accidents, and medical errors. Failure to ensure the safety of patients results in a
considerable rise in the cost of care, as well as morbidity and mortality. In the healthcare system,
patient safety is a top goal, not only to enhance treatment outcomes but also to prevent
consequences(Al-Ahmadi, 2009).
Nature of their work, nurses play a key role in protecting and supporting patients. They are the
first-line caregivers and devote more time to patient care than any other type of healthcare worker
(Balamurugan & Flower, 2015).Health care providers must prioritize patient safety, and they must
have a higher degree of understanding about patient safety in order to better recognize, interrupt,
and repair medical errors and protect patients (Safarpour et al., 2017).
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Nursing and medical students will be future healthcare professionals, it is vital to assess their
knowledge, attitude, and perceptions about patient safety (Mika Yoshikawa et al., 2013). Nursing
students are sometimes directly involved in unsafe treatment, errors, adverse events, and poor
patient care in clinical settings. As a result, they, like the rest of the healthcare team, should use
their knowledge, attitude, and perspective of patient safety when caring for the patient(Jamshidi et
al., 2021).
Nurses' perceptions are also the foundation of any behavior, and they lead to actions that have an
impact on patient safety, thus they are critical for all hospitals and healthcare providers (Mwachofi
et al., 2011).
One of the educational issues that leads to unsafe practice among nursing students is a lack of
patient safety information(Usher et al., 2017).As a result, nurses' attitudes toward patient safety
are critical in promoting a secure environment for patients(Brasaite et al., 2015).
It is now widely understood that optimum patient safety development is impossible without a safe
mindset in health-care settings(Alfaqawi et al., 2020).
All doctors and health-care personnel must be educated and taught in patient safety measures, and
this remains the foundation for best practices in health-care error prevention. However, patient
safety education is still a neglected topic, as most educators believe that safety procedures should
only be taught to professional doctors and nurses, and that students should not be involved in the
implementation or achievement of patient safety. In today's context of accountable health care, it's
more critical than ever to ensure that students understand about medical errors and how to improve
the delivery of safe health care by including patient safety measures(Buchan, 2008).
Medical errors and their implications in health care are becoming more common, and both the
medical profession and the general public are becoming more aware of them. Medical errors are
frequently reported in the media, particularly on social media, and have a direct impact on doctor-
patient relationships and confidence(Vincent et al., 2001).
When healthcare staff look after patients, they may make mistakes. In health care, typical errors
include failing to follow up on investigation findings or having poor medical records.
Approximately 10% of all hospital admissions result in medical errors. When mistakes like this
happen, they can be dangerous or even fatal (Makary & Daniel, 2016).
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Even while all health care workers are responsible for patient safety, the importance of ward
nurses' capacity to notice and respond to patient safety issues cannot be overstated(Massey et al.,
2017).
The research revealed that the middle-range hypothesis of patient safety goal priming via safety
culture communication could assist businesses in their success. According to this theory, hospital
safety culture communication promotes a previously held patient safety goal and raises the
perceived value of activities nurses can undertake to attain that aim. As a result, nurses place a
high priority on completing activities and risk assessments linked to patient safety, and they are
driven to do so (Groves & Bunch, 2018).
Patient safety assessment is a good predictor of hospital safety in general. It is critical that nurses
collaborate with other healthcare workers to develop and improve patient safety attitudes(Kim &
Jeong, 2019).
1.2 Problem statement
Every year, a large number of patients suffer from disabilities, injuries, or death as a result of poor
medical care. According to one study, 2.6 million patients die every year as a result of non-
compliance with safety requirements. This, in turn, has an impact on their families' personal, social,
and economic lives, exacerbating the loss(WHO, 2019).
According to the WHO (2019) report, adverse events as a result of hazardous care are one of the
top ten causes of death and disability worldwide. Every year, over 134 million adverse events
occur in hospitals in economically low- and middle-income nations as a result of improper care,
resulting in 2.6 million deaths. In primary and outpatient health care, up to 4 out of 10 individuals
are damaged, with over 80% of the injury being avoidable.
According to the research, around 98,000 people die each year as a result of medical errors in
hospitals. This is in addition to deaths caused by car accidents, workplace injuries, and breast
cancer.
Therefore, the aim of this study is to assess level of knowledge, attitude and practice towards
patient safety among nurses working at selected Hospitals in Mogadishu-Somalia.
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1.3 Objectives
1.3.1 General objective

To assess level of Knowledge, attitude and practice towards patient safety among nurses working
at selected Hospitals in Mogadishu-Somalia.
1.3.2 Specific Objectives

1-To identify level of knowledge about patient safety among nurses working at selected Hospitals
in Mogadishu-Somalia.
2- To assess level of attitude towards patient safety among nurses working at selected Hospitals in
Mogadishu-Somalia.
3-To determine the level of practice about patient safety among nurses working at selected
Hospitals in Mogadishu-Somalia.
1.4 Research questions

1. What is the level of knowledge about patient safety among nurses working at selected Hospitals
in Mogadishu-Somalia?
2. What is attitude towards patient safety among nurses working at selected Hospitals in
Mogadishu-Somalia?
3. What is practice about patient safety among nurses working at selected Hospitals in Mogadishu-
Somalia?
1.5 Significant of the Study

This study about knowledge, attitude and practice toward patient safety was educated the
respondents and was enhanced awareness of its knowledge, attitude and practice toward patient
safety among nurses working in selected hospitals in Mogadishu-Somalia as well as this study was
assessed nurses’ attitude toward patient safety to reduce harmful events in clinical settings,
Findings from this study therefore, expected to inform the decision makers and other stakeholders
about the attitude of nurses, helping them to revise and develop policies that influence nurses’
safety knowledge, attitude and practice towards patient safety.
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This study can be used by other researchers who are interested by using it as a reference and also
can be used by those who would like to do further research about knowledge, attitude and practice
towards patient safety. And also government officials and local NGOs can be used as beneficial
and making laws as reference.
1.6 Scope of the study

The scope has three dimensions’ content scope, time scope, and geographical scope
1.6.1 Content scope

This study will focus on Knowledge, attitude and practice towards patient safety among nurses
working
1.6.2 Geographical scope
This study will be carried out at selected Hospitals in Mogadishu-Somalia.
1.6.3 Time scope

This study started in March 2022 -July2002
1.6 Definition key terms

Good knowledge. When nurses respond the mean or above the mean score on knowledge
questions concerning to patient safety(Almaramhy et al., 2011; Biresaw et al., 2020; Nabilou et
al., 2015; Oliveira et al., 2017).
Poor knowledge. When nurses respond below the mean score on knowledge questions concerning
to patient safety(Almaramhy et al., 2011; Biresaw et al., 2020; Nabilou et al., 2015; Oliveira et al.,
2017).
Good attitude. When nurses respond the mean or above the mean score on attitude
questions regarding to patient safety(Almaramhy et al., 2011; Alonazi et al., 2016; Belay Gizaw
et al., 2018; Biresaw et al., 2020; Kiyancicek et al., 2014a; Tegegn et al., 2017).
Poor attitude. When nurses respond below the mean score on the attitude questions
regarding to patient safety(Almaramhy et al., 2011; Alonazi et al., 2016; Biresaw et al., 2020;
Gedif et al., 2018; Kiyancicek et al., 2014a; Tegegn et al., 2017).
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Good practice. When nurses respond the mean score on practice questions about
patient safety(Almaramhy et al., 2011; Biresaw et al., 2020; Bressan et al., 2020; Tegegn et al.,
2017).
Poor practice. When nurses respond below the mean score on practice questions about
patient safety(Almaramhy et al., 2011; Alonazi et al., 2016; Biresaw et al., 2020; Shojania et al.,
2001; Tegegn et al., 2017).
Nurses: is a profession within the health care sector focused on the care of individual, family and
community so they may attain, maintain, or recover optimal health and quality of life.
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CHAPTER TWO
LITERATURE REVIEW
2.0 Introduction
This chapter discusses the related literature regarding knowledge, attitude and practice towards
patient safety among nurses working at selected Hospitals in Mogadishu-Somalia. This chapter is
divided in three parts. first section discusses specific objective of the study one by one in detail
that give clear and deep understanding, second section every paragraph must be cited, third section
mention some research gaps about this study and conceptual framework.
2.1Knowledge towards patient safety
2.1.1Good knowledge
A study conducted in western Lithuania states that when compared to nurses with strong awareness
of patient safety, those with inadequate knowledge were 97 percent less likely to have a positive
attitude(Brasaite et al., 2015).
The responsibility for patient safety, on the other hand, should not be limited to the practice of
bedside nurses. Patient safety should instead be everyone's duty in the healthcare system.
Participants with good information may seek to establish positive safety attitudes, which could be
one explanation(Murray et al., 2018).
A study conducted in South Africa and Iran has found that the participants’ level of education was
significantly associated with good knowledge of pre- hospital emergency care. In this regard,
having a master’s and above educational level was found to be 6.04 times more to have good
knowledge as compared with diploma holders(Asadi et al., 2019; Mothibi et al., 2019).
2.1.2 Work experience

A study conducted in Manisa, Turkey has found that the participants who had attended patient
safety training were 2.9 times more likely to have good knowledge than those who had not. Nurses
with more than 10 years of experience were 2.7 times more likely to have good knowledge than
those with less than 10 years (81.34 percent). This disparity could be due to variances in how
various educational and training programs are implemented, as well as the country's developmental
condition, such as the construction of separate patient safety units in their institutions. A huge
percentage of nurses who do not comprehend patient safety endangers both patients and the
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medical profession. This result similar found south Korea.(Kiyancicek et al., 2014b). This might
be due to the fact that experience and training increases the chance of the trainees to get up to date
information about patient safety. Degree holders were 3.7 times and master holders were 4.32
times more likely to have good knowledge than diploma holders; and the odds of being
knowledgeable for those who were 30 years and older were 3.3 times higher than that of nurses
less than 30 years old. This is consistent with a study conducted in three multi-disciplinary
hospitals in Western Lithuania (Brasaite et al., 2015).
This could be because respondents with advanced degrees have taken some courses directly or
indirectly related to patient safety, or because they have many years of experience. Nurses who
received patient safety information during their continuing education program were 4.39 times
more likely than those who did not to have good knowledge. This is supported by a research
conducted in Western Lithuania(Brasaite et al., 2015).
Knowledge regarding to safety in complex systems is increasing and health care is a complex
system that is both growing and under pressure. Therefore, patient safety work also has to grow.
Basic situations for safe performance such as management that values safety, good working
circumstances, safety culture, enough staffing and competence, and equipment that facilitates safe
practice are important(Ros, 2020).
2.1.3 Medical errors

A study suggested in kingdom Saudi Arabia (KSA) has found that the majority of nurses agreed
and strongly agreed that they would report medication errors such as reporting an inadequate dose,
not giving the patient medication, and not giving the patient medication as recommended. On
addition, the vast majority demonstrated that they are well-versed in when to report a medication
error. Half of the nurses had a high total knowledge score, with an average of 31% of them having
a high total knowledge score. positive attitude toward patients' rights in any hospital department,
including justice, fairness, care, attention, respect, elimination of unpleasant and noisy factors, safe
environment, no racism, visiting times, companion, ability to use complaints and lawsuits, change
health institutions, emergency medical interventions, proper information, Nursery education,
adequate and qualified services(Ahmad Qasim Lamfon et al., 2019).
An incident description is followed by thorough clinical and patient information in the system.
Active learning and better health practices reduce the rate of negative events, hence preventing
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similar mistakes in the future. The health care provider must understand that drug error reporting
is a systemic failure, not the fault of the employer. When healthcare systems are approached from
a multidisciplinary perspective, errors are rarely the fault of a single person(Rishoej et al., 2018).
Despite the fact that drugs can be beneficial, they can also be harmful if misused. Several causes,
including a lack of performance, a lack of information, slips, and lapses, may be to blame for the
harm caused by prescription usage. Mistakes in medication administration can have a significant
impact on a patient's health care costs and quality of life, as well as on the health care providers
who care for them. It's important to improve knowledge about pharmaceutical mistakes and their
repercussions in order to decrease them(Ranchon et al., 2011; Rodziewicz et al., n.d.).
2.2 Attitude towards patient safety
2.2.1 Perception of management

A study conducted in Saudi Arabia has found that a drop in safety attitudes has been connected to
a lack of managerial guidance. Smaller hospitals may find it harder to provide resources for safety
training and management assistance, although such interventions are likely to improve patient
outcomes and reduce hospital error rates. Aside from the limitations of cross-sectional survey
designs in general, this study's conclusions include several methodological errors.
Due to the sensitivity of reporting medical errors, participants were only asked to estimate how
many medical errors they had reported in the previous year, limiting generalizations regarding the
impact of safety attitudes on error rates. This study has a low number of reported errors in
comparison to previous studies(Aljadhey et al., 2016; Aljarallah & Alrowaiss, 2013),should be
regarded with caution, as they may reflect participants' reluctance to admit mistakes rather than
low error rates. Although precise data on error rates may be difficult to come by, future research
on the link between safety attitudes and error rates could benefit from include validated indicators
of the quantity, nature, and severity of hospital errors.
Another disadvantage is that the results are limited in their generalizability because they are based
on self-reported questionnaires (in English) and the study was conducted in only a few Saudi
Arabian hospitals. English, on the other hand, is widely used in Saudi hospitals and has been
employed in similar studies in the country, as previously indicated. Another drawback was that all
of the participants were female. The results of future research would be(Sexton et al., 2006).
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This discovery corresponds was founded in Saudi Arabian probe (59.9%) have up-to-date patient
safety information during education boosts nurses' confidence in caring for their patients and
makes their job more evidence-based, which improves the quality of care provided. In the current
poll, 56.1 percent of nurses had a positive attitude toward patient safety. (Alonazi et al., 2016).
However, this was higher than the 50% figure seen in Palestinian hospitals (Elsous et al., 2016).
A study carried on in Europe has found that the differences in educational status, curriculum, and
developmental status between nations, as well as methodological variables like research design
variances, could explain the inequalities. Nurses under the age of 30 were 90% less likely than
those 30 and older to have a good attitude. Nurses who learned about patient safety during their
first education were 2.7 times more likely to have a good attitude, while nurses who did not learn
about patient safety during their continuing education were 3.7 times more likely. (Brasaite et al.,
2016).
2.2.2 Teamwork and working condition

A study controlled in Egypt has found that the attitude of nurses toward patient safety was found
to be poor. Patient safety was linked to educational level, years of experience, and previous training
in patient safety. The teamwork domain received the highest score in the current study, followed
by job satisfaction, management perception, working conditions, and safety climate in that order.
The lowest score was in the stress recognition domain. Nurses' attitudes about safety were mainly
neutral, according to the study. This outcome is in line with previous research(Bahar & Önler,
2020).
Patient safety is a multi-level framework including a variety of factors such as teamwork, climate
protection, employee satisfaction, working environment, stress awareness, management
perception, and attitude(Aboul-Fotouh et al., 2012; Carthon et al., 2019).
The importance of staff’s attitudes when creating a work environment where patient safety is a
high priority(L. C. Hughes et al., 2009). That years of job experience did not affect attitudes to
patient safety. Other studies reported that younger nurses’ attitude scores were lower than those of
their counterparts who had more experience(Dunstan & Coyer, 2020).
A study conducted in Iran the Medical students’ experiences has found during clinical rotations
can influence their attitudes toward patient safety and their future behavior. While positive
experiences enhance patient safety, negative experiences may lead to more harm to the patients.
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Even though many researches had been conducted elsewhere on medical students’ attitudes
towards patient safety(Saberi et al., 2017; Wetzel et al., 2012).
2.2.3 Job satisfaction

A study conducted in Izmir, Turkey has found that it could be related to the fact that patient safety
education influences their attitude, which in turn influences how they act and behave. Participants
who had undergone patient safety training were more likely to have a positive attitude than those
who had not (Ongun & Intepeler, 2017).
A study suggested in Bhutan, India found that the positive attitude toward patient safety is
associated with a significant reduction in complications (Pelzang & Hutchinson, 2018).Their
patient safety assessment serves as a reliable predictor of overall hospital safety. It is imperative
that nurses engage with other healthcare providers in the creation and enhancement of the attitude
towards patient safety(Kim & Jeong, 2019).
The importance of health care professional’s education has to be emphasized in order to gain
information, ability and attitude for safety patient care. Providing patient safety, is an important
topic that every country have to care about regardless of development level. Each year millions of
people have died or have fallen in no recover able permanent diseases because of health
professional’s errors. Because of this problem is caused both economical and moral losses, in
health institutions patient safety must be provided at all levels. Patient safety is the responsibility
of all health professionals(Vaismoradi, 2012; Wolf et al., 2006; World Health Organization, 2009).
Especially in recent years, sanctions for malpractice cases in new Turkish Penal Code have been
discussed. All health professionals have sufficient knowledge about patient rights within the
context of care duty. Almaramy et al (2011) evaluated knowledge and attitudes toward patient
safety among a group of undergraduate medical students and found that most of the participant
recognized the importance of patient safety topic and recognition of the role of patient in
preventing error(Almaramhy et al., 2011).
A study conducted in 2010 has found that the participants' understanding of medication mistake
reporting was satisfactory, and they agreed with the assertion that reporting drug errors is
everyone's duty. Our survey participants agreed that reporting medication mistakes occurred as a
result of medicine not being delivered, medication being administered that was not prescribed, or
medication not being received as recommended. Conversely, it was shown that individuals had a
11
common propensity to withhold reporting if they got an insufficient amount of the prescribed drug
(Sarvadikar et al., 2010).
2.2.4 Safety climate and nurses working unit

Patient safety attitude refers to the shared attitudes, beliefs, values, and assumptions that underlie
how people perceive and act upon safety issues within their organization(Carayon & Alvarado,
2007). The components are concerned with the healthcare providers’ attitudes about the
organization, the perceived work environment, perceived managerial support, and perceived
teamwork and supervision(Lee et al., 2018).
Patient safety and quality care are a foundation of health care systems and processes which are
essentially dependent upon nurses. Nurses should play a leadership role to achieve the goals of
patient safety and quality care(R. Hughes, 2008).
This contrasts with the findings that nurses have a negative impression of their working conditions
but a positive perception of the safety climate. The fundamental causes of the observed safety
attitudes discrepancy are unknown. Attitudes regarding safety culture reflect a complex culture
that emerges over time as a result of complex interactions between diverse individuals and
environments.(Modak et al., 2007).
The scope and specifics of hospital error rates linked to adverse patient events in Saudi Arabia are
difficult to come by. In Saudi Arabia, however, it is estimated that 40,000 medical error complaints
are filed each year, with 3455 medical malpractice instances sent to medical legal
committees(Saudi Arabia Ministry of Health, 2013).
A study was found in Gaza strip, Palestine nowdays is widely accepted that optimal patient safety
development is not possible without a safe attitude in health care facilities(Alfaqawi et al., 2020).
An unsafe attitude, on the other hand, is a forerunner to negative events since it forms and impacts
behavior. As a result, any shift in attitude has a major impact on people's safety behavior(Sheeran
et al., 2016).
The safety atmosphere of a large Saudi hospital was examined. According to the data,
approximately half of nurses believe the safety climate is unsafe, with nurses in the western region
having particularly strong feelings. Similar negative findings were revealed in two recent analyses
analyzing nurse perspectives. The first of the Saudi Ministry of Health's 649 nurses(MOH)(Dhafer
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Algahtani, 2015). There have also been few studies on safety attitudes in hospital settings where
medical workers come from a diverse range of cultural backgrounds, and how these attitudes relate
to error rates(Hofstede, 2001).
A study carried on in Saudi Arabia has found that the few research on patient safety attitudes in
hospitals with a varied range of cultural origins, and how these attitudes relate to error
rates(Creswell, n.d.).
Non-Saudis working in Saudi hospitals may have more negative attitudes toward safety culture
than Saudis since they are more open to expressing their personal thoughts and less concerned with
challenging the hospital's authority. In practically every indicator, doctors and nurses at the second
hospital showed weaker safety attitudes than those at the first facility, according to the research.
Employees at the second hospital, in particular, awarded the quality of their working conditions
and hospital management low marks, expressing displeasure with their positions. In this study,
respondents were asked how many medical errors they had reported in the preceding year, with
39.6 percent reporting they had reported at least one. Correlational analysis also found a strong
negative link between the two variables(Ausserhofer et al., 2013; Steyrer et al., 2013).
A study carried on in KSA has found that the several interventions have been recommended to
better a work environment, reduce errors, and improve care. These interventions include improving
communication and collaboration between physicians and nurses and being able to ask questions
to learn from mistakes to improve the teamwork climate(Murray et al., 2019).
2.3 Practice toward patient safety
2.3.1 Good practice

The level of practice was low to average among most of the nurses which is according with other
studies showing higher levels of underreporting of medication errors(Alsafi et al., 2015; Singh et
al., 2007). While it was in contrast with the Saudi study which showed higher levels of medication
reporting practices(Alsulami et al., 2019).
The conversion of patient safety into a specific body of knowledge is relatively latest and thus it
may be considered as a relatively new discipline. But, its concern is inherent to the practice of the
health care professions(Yamalik & Perea Pérez, 2012).However, to get married was 1.64 times
more likely to have good practice as compared with being single. The possible explanation might
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be those pairs would probably have better-shared information and minimized attention divert as
compared with being single. Besides, married healthcare professionals might be satisfied in their
work than that of a single one(Gedif et al., 2018).
Furthermore, the failure to overcome the obstacles to inter professional collaborative practice leads
patients at risk for unsafe care and harmful outcomes(Bell, 2014).
A study conducted in South Africa has found that the participants having greater than 10 years of
experience were 2.63 times more the odds of good practice than less than 5 years’
experience.(Alsafi et al., 2015; Asadi et al., 2019; Singh et al., 2007).
The major test in moving toward a safer healthcare system is patient safety culture, which is the
prevention of danger to the patients. Safe medical practices can avoid danger to the patients. For
this, healthcare professionals must have good attitudes regarding patient safety(Nadarajan et al.,
2020).
Nurses have an important role in the safe administration of medications, which includes, but is not
limited to, raising awareness of the risks associated with the possibility for medication mistakes.
Patient and medication assessment is carried out by nurses, who utilize their expertise and clinical
reasoning to ensure that medicine is administered safely(Dilles et al., 2021).
Nurses are the largest group of health care professionals that are the most interactive with patients.
The action of nurses is imperative for the adoption of safe practices and better quality
healthcare(Siman & Brito, 2017).
2.3.2 Procedure practice

Nurses use their fundamental understanding of patient conditions and organizational procedures
to apply clinical reasoning to ensure that medications are administered safely to their patients.
Clinical reasoning employed by nurses to support pharmaceutical safety was only partially
articulated, and there was little evidence to support this claim(Dilles et al., 2021; Keers et al.,
2018).
Patient safety can be improved by standardized handovers when encouraged by technological

solutions, face-to-face contact between nurses, and alongside bedside reports. However, changing
nursing handover practices to augment patient safety is complex. This includes changing the
culture, behavior, and roles of a clinical nursing settings(Bressan et al., 2020).
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Ensuring safety in healthcare settings is initiating improvements both in education and clinical
practice(Stevanin et al., 2015).
Patient safety has obtained enlarged consideration in current years. However, generally the focus
is on the magnitude of errors and adverse events rather than on practices that decrease the events.
Practices with strong supportive evidence are clinical interventions that reduce the risks linked to
hospitalization. Furthermore, the evidence-based strategy can support to investigate practices that
are more likely to improve patient safety(Shojania et al., 2001).
Furthermore, one in every ten patients is harmed while receiving hospital care as the world health
organization (WHO) considers patient safety as an endemic and epidemic concern(Abdelhai et al.,
2012).
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1.7 Conceptual Frame Work
IV
Knowledge towards patient safety

DVInitial education
Continuing education
Training about patient safety
Clinical environment
Medical errors
Role in preventing errors
Human errors
Adverse event
Health care organization
Attitude towards patient safety DV
Lack of managerial assistance
Lower hospital mistake rates
Health care workers
Fatigue impairs performance
Team working
Job satisfaction and perception of
management Patient safety
Working conditions and safety
climate
A positive attitude
Leadership role
Practice towards patient safety
Safe medical practices
Standardized handovers
Medication mistakes
Clinical reasoning and administered
safely
Imperative for the adoption
Organizational procedures
Pharmaceutical safety
Clinical nursing settings
Practices with strong supportive
evidence
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CHAPTER THREE
RESEARCH METHODOLOGY
3.0 Introduction
This chapter presents study design, study population, inclusion and exclusion criteria, sample size
determination, sampling procedure/techniques, research instrument, data collection methods,
validity and reliability of the study data analysis procedure, and ethical consideration of the study.
3.1 Study design

This study was used descriptive cross-sectional study design was conducted among staff nurses
working at selected hospital in Mogadishu-Somalia.
3.2 Study population

The target population of this study were staff nurses and volunteers working at Selected Hospitals
in Mogadishu-Somalia.
3.3 Selection criteria
3.3.1 Inclusion criteria
Nurse’s staff working at selected Hospitals in Mogadishu-Somalia was included in this study.
3.3.2 Exclusion criteria
Nurse’s students who were in training in the hospitals or those who were not willing to participate
this study.
3.4 Sample size determination

The sample size was taken to the all nurses staff working in those selected hospitals which were
202 total.
3.5 Sampling procedure

Simple random sampling technique was used to select the study subjects from nurse’s staff
working at selected Hospitals in Mogadishu-Somalia. During this, primarily, the lists of staff
nurses was obtained from the hospitals. Then, based on the list obtained, a lottery method was used
to select the study participants.
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3.6 Research instrument and tools
3.6.1 Research instruments

Structured self-administered questionnaire was used to collect data from the nurse’s staff working
at selected hospitals in Mogadishu-Somalia.
3.7 Data collection and procedure
Structured self-administered questionnaire was used to collect data from the nurse’s staff working
at selected hospitals.
The questionnaire was included socio-demographic characteristics, knowledge towards patient

safety, attitude towards patient safety, and practice towards patient safety. During this time, nurse’s
staff working was participated in this process. The questionnaire was prepared in English then
translated in to Somali.
3.8 Data analysis procedure
The data was entered and analysis using Statistical Package for Social Science (SPSS) version 20
and Excel. After the entry, a descriptive statistic such as frequency, percentage, mean and standard
deviation is used to present the background characteristics of the participants.
3.9 Quality control
3.9.1 Validity
This study was used questionnaire as instrument for data collection. The questionnaire was ensured
to have all variable necessary to asses’ knowledge, attitude and practice toward patient safety then
it was sent Supervisor and his comments and suggestion was included.
3.9.2 Reliability
To ensure the reliability of the questionnaire it was used pretested to 15staff nurses working from
actual nurses.
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3.10 Ethical consideration
This study was asked approval from Jazeera University Research Office. The letter of permission
was sent to selected hospitals. The nurses were informed about the objectives of the study and
confidentiality issues prior to data collection. For the reason of privacy and confidentiality,
personal identifiers were not being used. The nurses were also informed that they have the right to
withdraw from the study at any phase. After brief information was offered concerning the
objectives and significance of the study for the nurses, written informed consent is gained.
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CHAPTER FOUR
DATA PRESENTATION, ANALYSIS AND INTERPRETATION
4.0 INTRODUCTION
Cross sectional study was done & results of the study presented in this unit, data analysis obtained
from the respondents in this study by using questionnaire. This data contains tables & figures so a
total of 202 nurses were enrolled in to the study response rate were 100%.
4.1 Personal information
As table 4.1 shows the mean (±SD) age of the nurses was (±5.54) 25years and the majority of them
179 (88.6%) were aged 18-30 years. In regard to sex majority of nurses 167(82.7%) were female,
while 35(17.3%) were male. Regarding to the educational qualification, the majority 180(89.1%)
of the nurses were bachelor degrees and only 10(5.0%) of nurses were diploma. Regarding to the
marital status, about two-third 134(66.3) of nurses were single, while the remaining 66(32.75%)
were married. A major proportion 167(82.7%) of the nurses had working experience of 1-5years,
while 23(11.4%) had experience 6-10 years of 7(3.5%) of the nurses had experience of 11-15 years
and only 5(2.5%) of the nurses had experience of >15 years. Regarding to the working unit, more
than half 120 (59.4%) of the nurses were working inpatient, followed by those who were of nurses
working in Emergency 37(18.3%), followed outpatient 22(10.9%), ICU 20(9.9%) and the OT 3
(1.5%). In regards to work position 170(84.2) were staff nurses, while 32(15.8%) were head nurse.
As regards to working hours, the majority 142(70.3) of the nurses had a Length of 41-49 hours per
week and only 1(0.5%) Nurses had working length of <40 hours working hours per week.
20
Table 4.1 Personal information among patient safety

Variables Category Frequency Percent
Age 18-30 years 179 88.6%
31-40 years 19 9.4%
41-50 years 2 1.0%
Above 50 years 2 1.0%
Mean(SD) = 25.628 (± 5.5481) Years
Gender Male 35 17.3%
Female 167 82.7%
Educational level Diploma 10 5.0%
Bachelor 180 89.1%
Master 12 5.9%
Marital status Single 134 66.3%
Married 66 32.7%
Divorced 1 .5%
Widowed 1 .5%
Experience 1-5 167 82.7%
6-10 23 11.4%
11-15 7 3.5%
>15 5 2.5%
Mean(SD) = 4.1039 (± 4.1024) Years
Work Unit Inpatient 120 59.4%
Outpatient 22 10.9%
Emergency 37 18.3%
ICU 20 9.9%
OT 3 1.5%
Work position Head nurse 32 15.8%
Staff nurse 170 84.2%
Work hours <40 1 .5%
41-49 142 70.3%
>50 59 29.2%
Mean(SD) = 51.2178 (±6.175) Years
21
4.2 Knowledge related patient safety
According to shows that the majority of the nurses 190(94.1%) stated they had “information about
patient safety during initial educational” and only 12(5.9%) had stated they had no. Majority of
nurse 191(96.4%) had claimed they have “Information about patient safety continue education"
and only 11(5.4%) had stated they had no. the majority had responded yes to the “training about
patient safety” 181(89.6%) had indicated and only 21(10.4%) had indicated they had no training
about patient safety. The majority of the nurses 158(78.2%) had indicated they have “clinical
environment can cause error” and only 61(30.2%) had indicated they had no clinical environment
can cause error. The majority of the nurses 141(69.8%) had indicated they have “medical error
sign of incompetence” and only 61(30.2%) had indicated they had no clinical environment can
cause error. The majority of the nurses 169(83.7%) had claimed they have “expertise that patient
have important role in preventing error” and only 33(16.3%) had claimed they had no expertise
that patient have important role in preventing error. the majority of the nurses 172(85.1%) had
stated they have “human errors are inevitable” while and only 30(14.9%) had stated they had no
human errors are inevitable. The majority of the nurses 177(87.6%) had stated they have “an
adverse event is an event that effected the patient” and Only 25(12.4%) had stated they had on an
adverse event is an event that effected the patient. The majority of the nurses 183(90.6%) had
claimed they have “patient safety a characteristics of highly reliable health care organization” and
only 19(9.4%) had claimed they had no patient safety a characteristics of highly reliable health
care organization. The majority of the nurses (77.7%) had claimed they have “mistake is a failure
to execute an action plan as intended or implementation of wrong plan” and only 45(22.3%) had
claimed they had no mistake is a failure to execute an action plan as intended or implementation
of wrong plan.
22
Variables Yes No
Do you have information about patient safety during initial 190(94.1%) 12(5.9%)
education?
Do you have information about patient safety during continue 191(96.4%) 11(5.4%)
education?
Do you have training about patient safety? 181(89.6%) 21(10.4%)
Do you think that clinical environment can be cause error? 158(78.2%) 44(21.8%)
Do medical errors sign of incompetence? 141(69.8%) 61(30.2%)
Do you have expertise that patient have important role in 169(83.7%) 33(16.3%)
preventing error?
Do you believe that human errors are inevitable? 172(85.1%) 30(14.9%)
Do you think that an adverse event is an event that effected the 177(87.6%) 25(12.4%)
patient?
Does patient safety a characteristics of highly reliable health care 183(90.6%) 19(9.4%)
organization?
Do you believe that mistake is a failure to execute an action plan 157(77.7%) 45(22.3%)
as intended or implementation of wrong plan?
Table 4.2 Knowledge towards patient safety
23
4.3Attitude toward patient safety

According to the statement “Lack of managerial assistance has been linked to decrease in patient
safety” majority of the nurses had agreed 105(52.0%), had strongly agreed 33(16.3%), followed
by those whose who were neutral 28(13.9%), had disagree 22(10.9%), those who were strongly
disagree 33(16.3%). Concerning to the statement “lower hospital mistake rates enhance patient
outcomes” the majority of the nurses had agreed 90(44.6%), had strongly agreed 24(11.9%),
followed by those whose who were neutral 30(14.9%), had disagree 31(15.3%), those who were
strongly diagree27(13.4%).
Regarding to the statement “health care workers work together as well as coordinated team”
majority of nurses had agreed 84(41.6%), had strongly agreed 51(25.2%), followed by those whose
who were neutral 13(6.4%), had disagree 21(10.4%), those who were strongly disagree 33(16.3%).
In regards to “Fatigue impairs any performance during emergency situation” majority of nurses
had agreed 103(51.0%), had strongly agreed 26(12.9%), followed by those whose who neutral
32(15.8%), had disagree 14(6.9%), those who were strongly disagree 27(13.4%).
Concerning toward statement “team working may enhance the improvement of patient safety
positively” majority of nurses had agreed 97(48%), had strongly agreed 40(19.8%), followed by
those who neutral 23(11.4%), had disagree 15(7.4%), these who were strongly disagree 27(13.4%).
Regarding to statement “job satisfaction and perception of management can contribute nurse
attitude toward patient safety” the majority of nurses had agreed 120(59.4%), had strongly agree
31(15.3%), followed by those who neutral 21(10.4%), had disagree 14(6.9%), those who were
strongly disagree 16(7.9%).
According to the statement “working conditions and safety climate can take part collaboration of
nurse's attitude towards patient safety” the majority of nurses had agreed 80(39.6%), had strongly
agreed 33(16.3%), followed by those who neutral 48(23.8%), had disagree 22(10.9%) those who
were strongly disagree 19(9.4%).
Regarding to statement “positive attitude toward patient safety is associated with significant
reduction in complications” the majority of nurses had agreed 95(47.0%), had strongly agreed
35(17.3%), followed by those whose who neutral 25(12.4%), had disagree19(9.4%), those who
were strongly disagree 28(13.9%).
24
According to the statement “nurses should play a leadership role to achieve the goals of patient
safety and quality care” the majority of nurses had agreed 84(41.6%), had agreed 65(32.2%),
followed by those whose who neutral 15(7.4%), had disagree 9(4.5%), those who were strongly
disagree 29(14.4%). Regarding to the statement “several interventions have been recommended to
better a work environment reduce errors and improve care” the majority of nurses had agreed
114(54.4%), had strongly agreed 34(16.8%), followed by those whose who neutral 22(10.9%), had
disagree 4(2.0%), those who were strongly disagree 28(13.9%).
Table 4.3 Attitude toward patient safety
Variables Strongly Disagree, Neutral Agree Strongly

disagree, N (%) N (%) N (%) agree
N (%) N (%)
Lack of managerial assistance has been linked 33(16.3%) 22(10.9%) 28(13.9%) 105(52.0% 14(6.9%)
to decrease in patient safety. )
Lower hospital mistake rates enhance patient 27(13.4%) 31(15.3%) 30(14.9%) 90(44.6%) 24(11.9%)
outcomes.
Health care workers work together as well as 33(16.3%) 21(10.4%) 13(6.4%) 84(41.6%) 51(25.2%)
coordinated team.
Fatigue impairs any performance during 27(13.4%) 14(6.9%) 32(15.8%) 103(51.0% 26(12.9%)
emergency situation. )
Team working may enhance the improvement 27(13.4%) 15(7.4%) 23(11.4%) 97(48%) 40(19.8%)
of patient safety positively.
Job satisfaction and perception of management 16(7.9%) 14(6.9%) 21(10.4%) 120(59.4% 31(15.3%)
can contribute nurse attitude toward patient )
safety.
Working conditions and safety climate can take 19(9.4%) 22(10.9%) 48(23.8%) 80(39.6%) 33(16.3%)
part collaboration of nurse's attitude towards
patient safety.
Positive attitude toward patient safety is 28(13.9%) 19(9.4%) 25(12.4%) 95(47.0%) 35(17.3%)
associated with significant reduction in
complications.
Nurses should play a leadership role to achieve 29(14.4%) 9(4.5%) 15(7.4%) 84(41.6%) 65(32.2%)
the goals of patient safety and quality care.
Several interventions have been recommended 28(13.9%) 4(2.0%) 22(10.9%) 114(54.4% 34(16.8%)
to better a work environment reduce errors and )
improve care.
25
4.4 Practice related patient safety
According to the statement the majority of nurses 195(96.5%) indicated that they “can safe medical
practices avoid danger to the patients” and only 7(3.5%) had indicated they had no can safe medical
practices avoid danger to the patients. The majority of nurses 178(88.1%) had stated they have
“patient safety can be improved by standardized handover when encouraged by technological
solutions” and only 24(11.9%) had stated they had no patient safety can be improved by
standardized handover when encouraged by technological solutions. According to the statement
the majority of the nurses 169(83.7%) had indicated they have “risks associated with medication
mistakes can devastate the safety of patient” and only 33(16.3%) had indicated they had no risks
associated with medication mistakes can devastate the safety of patient. According to the statement
the majority of nurses 182(90.1%) had claimed “clinical reasoning to ensure that medicine is
administered safely can be conducted right time and right patient for nurses” and only 20(9.9%)had
claimed they had no clinical reasoning to ensure that medicine is administered safely can be
conducted right time and right patient for nurses.
Regarding to the statement of the majority of nurses 190(94.1%) had claimed they have “the action
of nurses is a imperative for adoption of safe practice and better quality of health care” and only
12(5.9%) had claimed they had no the action of nurses is a imperative for adoption of safe practice
and better quality of health care. In regards to the majority of nurses 183(90.6%) had indicated
they have “nurse use their fundamental understanding of patient conditions and organizational
procedures” and only 19(9.4%) had indicated they had no nurse use their fundamental
understanding of patient conditions and organizational procedures.
According to the statement the majority of nurses 176(87.1%) had indicated they have “clinical
reasoning employed by nurses to support pharmaceutical safety was only partial articulated” and
only 26(12.4%) had indicated they had no clinical reasoning employed by nurses to support
pharmaceutical safety was only partial articulated.
Regarding to the statement the majority of nurses 177(87.6%) had indicated they have “changing
nursing handover practices can change the culture, behavior and roles of a clinical nurse settings”
and only 25(12.4%) had indicated they had no changing nursing handover practices can change
the culture, behavior and roles of a clinical nurse settings.
26
In regards to the majority of nurses 183(90.6%) had responded yes to the statement “practice with
strong supportive evidence are clinical interventions that reduce the risks linked to hospitalization”
and only 19(9.4%) had responded they had no practice with strong supportive evidence are clinical
interventions that reduce the risks linked to hospitalization. According to the statement the
majority of nurses 185(91.6%) had stated they have “evidence based strategy can support to
investigate practices that are more likely to improve patient safety” and only 17(8.4%) had stated
they had no evidence based strategy can support to investigate practices that are more likely to
improve patient safety.
27
Table 4.4 Practice related patient safety
Variables Yes No
Can safe medical practices avoid danger to the patients? 195(96.5%) 7(3.5%)
Patient safety can be improved by standardized handover when 178(88.1%) 24(11.9%)
encouraged by technological solutions.
Risks associated with medication mistakes can devastate the safety 169(83.7%) 33(16.3%)
of patient.
Clinical reasoning to ensure that medicine is administered safely 182(90.1%) 20(9.9%)
can be conducted right time and right patient for nurses.
The action of nurses is a imperative for adoption of safe practice 190(94.1%) 12(5.9%)
and better quality of health care.
Nurse use their fundamental understanding of patient conditions 183(90.6%) 19(9.4%)
and organizational procedures.
Clinical reasoning employed by nurses to support pharmaceutical 176(87.1%) 26(12.9%)
safety was only partial articulated.
Changing nursing handover practices can change the culture, 177(87.6%) 25(12.4%)
behavior and roles of a clinical nurse settings.
Practice with strong supportive evidence are clinical interventions 183(90.6%) 19(9.4%)
that reduce the risks linked to hospitalization.
Evidence based strategy can support to investigate practices that 185(91.6%) 17(8.4%)
are more likely to improve patient safety.
28
knowledge level
43%
57% good knowledge
poor knowledge
Figure 4.1 Knowledge patient safety

Figure 4.2 shows that more than half of the nurses (57%) had good knowledge on patient safety,
while (43%) others had poor knowledge level.
Figure 4.3 Attitude patient safety

Figure 4.3 shows that more than one-third (38%) of the nurses had poor attitude on patient
safety.
29
Practice level
27%
good practice
73% poor practice
Figure 4.3 Practice patient safety

Figure 4.4 shows that a quarter (27%) or the nurses had poor practice towards patient safety.
30
CHAPTER FIVE
DISCUSSION, CONCLUSION AND RECOMMENDATION
5.0 Introduction
This chapter presents the discussion of the results derived from the data presented in chapter four
and chapter two. The discussion leads to varying conclusions and a number of recommendations
that are presented later. Knowledge, attitude and practice towards patient safety among nurses
5.1 Discussion of the result

The present study was done to assess the knowledge, attitude, and practice towards patient safety
among nurses working at selected hospitals in Mogadishu-Somalia. This is because
The nurses level of knowledge, attitude and practice towards patient safety was a cornerstone for
the management and control of the morbidity and mortality associated with errors and harms
during medical care services.
The present study was showed that the nurses’ level of knowledge towards patient safety good was
56.9% (95%CI; 50.2% to 63.6%).The result of this study was higher when compared with a study
conducted in University of Gondar specialized hospital where nurses’ level of knowledge towards
patient safety good was 48.4% (Biresaw et al., 2020). This might be due to the differences in
sample size (386) and number of nurses who had taken training on patient safety 60(15.5%), while
the current study of sample size was (202) and nurses who was taken training on patient safety
181(89.6%).
The present study was founded lower when compared with a study conducted in Public University
of Parana´, Brazil, which reported the knowledge of nurses’ towards patient safety as 89.8%
(Oliveira et al., 2017).The variation might be due to that the differences sample size (113) and total
response rate 78(69%), while the current of study of sample size was (202) and response rate
202(100%).
The result of this study was also lower when compared with a study conducted in Urmia University
of Medical Sciences, West Azerbaijan province, Iran, where the level of knowledge towards
patient safety good was 50% (Nabilou et al., 2015). The variation might be due to that the
31
difference the study population. A study conducted in Urmia University of Medical Sciences, West
Azerbaijan province, Iran, was done among the students studying medicine, nursing, and
midwifery. However, this study was conducted among the staff nurses working in hospitals only.
The current study was showed that majority of the nurse’s level of attitude towards patient safety
was good as 62.4% (95%CI; 55.72% to 69.08%). The result of the current study was similar when
compared with a study conducted in University of Gondar specialized hospital where nurses’ level
of good attitude toward patient safety was 56.1% (Biresaw et al., 2020).
The result of the present study was lower when compared with a study conducted in University of
Gondar, Ethiopia where the level of attitude of patient safety good was (84.33%) (Tegegn et al.,
2017).The variation might be due to that the difference in sample size was (83) and study
population was only pharmacy students respectively for the study done in university of Gondar
while sample size of the present study was (202), and study population were nurses.
The result of the present study was also lower when compared with a study conducted in Manisa,
Turkey, where the nurses’ attitude towards patient safety was (100%)(Kiyancicek et al., 2014b).
The variation might be due to that the difference in study population were health staffs who 194
(61.0%) staff nurses, 30 (9.4%) nurse managers, 42 (13.2%) midwifes, and 52 (16.4%) health
officers while study population were only staff nurses.
The current study was showed that majority of the nurses 73% (95%CI; 66.7%to 78.93%) had
good practice toward patient safety. The result of the current study was higher when compared
with a study conducted in Asella Referral and Teaching Hospital, Ethiopia to their different have
a good practice towards patient safety 50% (Wake et al., 2021). This might be due to the difference
in study period from December 28, 2020 to January 05, 2021 from 1 hospital, while the current
study of study period from March 16, 2022 to September 22, 2022 from 3 hospitals.
The result of the present study was also higher when compared to a study conducted in Jimma
Zone Public Hospitals, Ethiopia, where the participants of practice toward patient safety was
(36.77%)(Belay Gizaw et al., 2018). This result showed that the hospitals had low patient safety
practice. This might be due to the difference in total response rate 306 (98.1%) from 5 Hospitals
of Jimma zone in Ethiopia and the participants were health care providers, while the current study
of total response rate 202(100%) from 3 hospitals in Somalia and the participants were only staff
nurses.
32
5.2 Limitation of the study

This study relied on a questionnaire where there no observations to confirm whether the nurses
were doing the correct practice or not and the level of knowledge, attitude and practice towards
patient safety among nurses were not adequately assessed in all hospitals in Mogadishu-Somalia.
There was no much available documented literature on patient safety in Somalia.
5.3 Conclusion
The present study was focused on determination of knowledge, attitude and practice levels toward
patient safety among nurses working at selected hospitals in Mogadishu-Somalia.
The result of the current study had shown that the majority of the nurse’s had good knowledge,
good attitude and good practice level towards patient safety.
5.4 Recommendation
Based on study results, the researchers recommend the following:
a) To solve issues like medical errors, nurses may require patient safety training and education
programs.
b) Nurses should work together as a team to enhance patient safety.
c) Hospital administrators need to prepare leaflets and reading materials about patient safety
to nurses.
d) The administrators to encourage nurse’s staff to incidence reporting.
e) Future researchers to make further studies of patient safety in other hospitals.
33
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42
APPENDEX IA: CONSENT FORM IN ENGLISH
Title: Knowledge, attitude and practice towards patient safety among nurses working at
selected hospitals in Mogadishu-Somalia.
I am student from x university under the faculty of health science department of nursing as part of
my course requirement I am conducting a research thesis entitled “knowledge, attitude and practice
towards patient safety among nurses working at selected hospitals in Mogadishu-Somalia”.
The Objective of this study is to determine knowledge attitude and practice towards patient safety
among nurses working at selected hospitals in Mogadishu-Somalia.
Who are included this study
All nurses’ staff working at selected hospitals in Mogadishu-Somalia will be included in this study
Mogadishu-Somalia.
Potential benefits
You will not receive direct benefit from participation in this study; however, the results from this
study may be helpful for the health sector of the country to improve interventions that are aimed
at improving patient safety in Somalia generally and particularly at selected hospitals in
Mogadishu-Somalia.
Confidentiality
I would like to inform you that your information will be treated as most confidential, it will not
publish or use in any other purpose.
Potential risk
I do not expect any unusual risk to occur you as result of participation in this study. Right to refuse
your participation to this study will be voluntary and you may withdraw at any time during this
study period without any consequences.
Declaration
Signing this consent, you will declare that you have read this consent form or have had it read to
you. You will fully and voluntarily agree with the interviewer to participate in this study.
I agree
I disagree
Signature of the participant ____________ Date: / / 2022
43
APPENDIX IIA: QUESTIONNAIRE-ENGLISH
I am a nursing bachelor degree student at X University. As part of the requirement for the award
of the degree we are required to undertake a research our response choose this questionnaire is not
only critical to the study but highly appreciated
The study Title: KNOWLEDGE, ATTITUDE AND PRACTICE TOWARD PATIENT SAFETY
AMONG NURSES WORKING AT SELECTED HOSPITALS IN MOGADISHU-SOMALIA.
• Do not write your name on the questionnaire.

• The research is for academic purpose and not for money.
• All information will be private.
PART I: PERSONAL INFORMATION

1. Age in years………………..years
2. Gender
a) Male
b) Female
3. Educational qualification
a) Diploma
b) Bachelor degree
c) Master
4. Marital status
a) Single
b) Married
c) Divorced
d) Widowed
5. Years of experience…………….years
6. Working unit
a) Inpatient
b) Outpatient
c) Emergency
d) ICU
44
e) OT
7. Work position
a) Head nurse
b) Staff nurse
8. Working hours per weeks…………..hours
Part II: Knowledge towards patient safety

1. Do you have an information about patient safety during initial education?
a) Yes
b) No
2. Do you have an information about patient safety during continuing education?
a) Yes
b) No
3. Do you have a training about patient safety?
a) Yes
b) No
4. Do you think that clinical environment can be a cause of errors?
a) Yes
b) No
5. Do medical errors sign of incompetence?
a) Yes
b) No
6. Do you have an expertise that patients have an important role in preventing errors?
a) Yes
b) No
7. Do you believe that human errors are inevitable?
a) Yes
b) No
45
8. Do you think that an adverse event is an event that affected the patient?
a) Yes
b) No
9. Does patient safety a characteristic of highly reliable health care organization?
a) Yes
b) No
10. Do you believe that mistake is a failure to execute an action plan as intended or an
implementation of the wrong plan?
a) Yes
b) No
Part III: Attitude towards patient safety
1. Do you believe that lack of managerial assistance has been linked to a decrease in
patient’s safety?
a) Yes
b) No
2. Does lower hospital mistake rates enhance patient outcomes?
a) Yes
b) No
3. Do the health care workers work together as a well-coordinated team?
a) Yes
b) No
4. Do you think that fatigue impairs any performance during emergency situations?
a) Yes
b) No
5. Do you believe that team working may enhance the improvement of patient safety
positively?
a) Yes
b) No
46
6. Job satisfaction and perception of management can contribute nurse’s attitude
towards patient safety
a) Yes
b) No
7. Working conditions and safety climate can take part collaboration of nurse’s
attitude toward patient safety
a) Yes
b) No
8. A positive attitude toward patient safety is associated with a significant reduction
in complications
a) Yes
b) No
9. Nurses should play a leadership role to achieve the goals of patient safety and
quality care
a) Yes
b) No
10. Several interventions have been recommended to better a work environment,
reduce errors, and improve care
a) Yes
b) No
Part IV: Practice related questionnaires
1. Can safe medical practices avoid danger to the patients?
a) Yes
b) No
2. Patient safety can be improved by standardized handovers when encouraged by

technological solutions
a) Yes
b) No
47
3. Risks associated with medication mistakes can devastate the safety of the patient
a) Yes
b) No
4. Clinical reasoning to ensure that medicine is administered safely can be conducted
right time and right patient for nurses
a) Yes
b) No
5. The action of nurses is imperative for the adoption of safe practices and better
quality healthcare
a) Yes
b) No
6. Nurses use their fundamental understanding of patient conditions and
organizational procedures
a) Yes
b) No
7. Clinical reasoning employed by nurses to support pharmaceutical safety was only
partially articulated
a) Yes
b) No
8. Changing nursing handover practices can change the culture, behavior, and roles
of a clinical nursing settings
a) Yes
b) No
9. Practices with strong supportive evidence are clinical interventions that reduce
the risks linked to hospitalization
a) Yes
b) No
10. The evidence-based strategy can support to investigate practices that are more
likely to improve patient safety
a) Yes
b) No
48
APPENDIX III: BUDGET
Description Total Cost

Transportation of the research team 30$
Internet 80$
Proposal printing 20$
Thesis printing 40$
Refreshments 20$
Total 190$
49
APPENDIX IV: WORK PLAN
Activities Jan Feb Mar April May Jun Jul Aug Sep
Consultation
with The
Supervisor
Proposal
Writing
Submission Of
The Final
Proposal
Data Collection,
Analysis
Report Writing
Submission Of
The Report
50
Somalia map
51

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Knowledge, attitude and practice towards patient safety among nurses

working at selected Hospitals in Mogadishu-Somalia.

1.1 Background of the study

1.2 Problem statement

1.3.1 General objective

1.3.2 Specific Objectives

1.4 Research questions

1.5 Significant of the Study

1.6 Scope of the study

1.6.1 Content scope

1.6.2 Geographical scope

This study will be carried out at selected Hospitals in Mogadishu-Somalia.

1.6.3 Time scope

1.6 Definition key terms

2.1Knowledge towards patient safety

2.1.2 Work experience

2.1.3 Medical errors

2.2 Attitude towards patient safety

2.2.1 Perception of management

2.2.2 Teamwork and working condition

2.2.3 Job satisfaction

2.2.4 Safety climate and nurses working unit

2.3 Practice toward patient safety

2.3.1 Good practice

2.3.2 Procedure practice

Patient safety can be improved by standardized handovers when encouraged by technological

1.7 Conceptual Frame Work

Knowledge towards patient safety

3.1 Study design

3.2 Study population

3.3.2 Exclusion criteria

3.4 Sample size determination

3.5 Sampling procedure

3.6 Research instrument and tools

3.6.1 Research instruments

3.7 Data collection and procedure

The questionnaire was included socio-demographic characteristics, knowledge towards patient

3.8 Data analysis procedure

3.9 Quality control

Table 4.1 Personal information among patient safety

4.2 Knowledge related patient safety

Do medical errors sign of incompetence? 141(69.8%) 61(30.2%)

4.3Attitude toward patient safety

Table 4.3 Attitude toward patient safety

Variables Strongly Disagree, Neutral Agree Strongly

Figure 4.1 Knowledge patient safety

Figure 4.3 Attitude patient safety

Figure 4.3 Practice patient safety

5.1 Discussion of the result

5.2 Limitation of the study

Al-Ahmadi, T. A. (2009). Measuring Patient Safety Culture in Riyadh’s Hospitals: A Comparison

Creswell, J. W. (n.d.). Educational research : planning, conducting and evaluating quantitative

Hofstede, G. (2001). Culture’s Consequences: Comparing Values, Behaviors, Institutions, and

• Do not write your name on the questionnaire.

PART I: PERSONAL INFORMATION

Part II: Knowledge towards patient safety

2. Patient safety can be improved by standardized handovers when encouraged by

APPENDIX III: BUDGET

Description Total Cost

Creswell, J. W. (n.d.). Educational research : planning, conducting and evaluating quantitative